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Monday, September 1, 2014
- Despite pledges from governments across Eastern Europe and Central Asia to fight HIV/AIDS – one of the eight Millennium Development Goals – the region has the world’s fastest-growing HIV epidemic.
Punitive drug policies, discrimination and problems with access to medicines and important therapy are all driving an epidemic which is unlikely to be contained, world experts say, until governments in countries with the worst problems change key policies and approaches to the disease.
Daniel Wolfe, director of the International Harm Reduction Development Programme at the Open Society Foundations, told IPS: “In most post-Soviet countries, where HIV remains concentrated among injecting drug users, harsh policies and discrimination in healthcare settings continue to cripple the AIDS response.”
Figures showing the extent of the region’s problems with the disease make grim reading. According to the World Health Organisation (WHO), while HIV infection rates are actually falling globally, Eastern Europe and Central Asia (EECA) is seeing the reverse.
The WHO says that there were 170,000 new HIV infections in the region in 2011. New infections have risen 22 percent in the EECA since 2005, and there is no sign of a slowdown.
Injection drug use has been identified as fuelling the epidemic – accounting for up to 70 percent of new infections, according to the WHO.
Activists say the key to tackling the epidemic lies first and foremost in combating the injecting drug use problem, but that official and unofficial stances towards drugs and their users are stopping the problem being effectively tackled, or are even making it worse.
Dasha Ocheret of the Eurasian Harm Reduction Network, told IPS: “Punitive drug policies have to be stopped. People are afraid to get treatment for fear of criminal prosecution or problems with the police in other forms and there are situations where people would rather risk getting HIV than go somewhere like a needle exchange centre.”
Russia and the Ukraine are widely seen as facing the greatest problems, with official policies in the former being blamed for hindering the fight against HIV/AIDS in other countries in the region too.
Opiate-substitution therapy (OST), a treatment for drug users in which methadone or buprenorphine are provided to heroin users, which is standard practice in much of the rest of the world, is banned by law in Russia. Public promotion of its use is punishable by jail.
Critics of methadone treatment in Russia argue that it keeps patients in addiction, while others claim western countries want the treatment offered in Russia for commercial gain. They also warn that methadone would probably end up being sold on the black market, sparking another drug problem.
But with Russia emerging in recent years as a major donor in the EECA region, it is also exporting its policies, including on OST, along with its money, and there are fears this could lead to OST programmes being shelved or restricted in other states.
“Russia is a serious regional player and its policy on drugs, like its policies on other drugs, influence policies in other countries in the region,” said Ocheret.
UNAIDS officials have publicly said that the spread of HIV among injecting drug users could be largely stopped if OST, combined with needle exchange programmes, were offered.
This is a view backed up by groups such as Harm Reduction International, which told IPS that huge differences – up to 30 percent – in prevalence rates of HIV among injecting drug users in western countries and Russia is down to the provision of OST and needle exchange programmes.
But even in EECA countries where needle exchange and OST schemes are on offer, there are often serious problems with access to them.
In many EECA countries government officials continue to question their effectiveness and refuse to support them financially, leaving programmes relying on donor support.
This can limit the coverage, scale and subsequent effectiveness of such programmes, and, because such funding is rarely indefinite, creates fear among those on them that their access to OST could be suddenly cut off if a programme closes.
But a greater problem is the active persecution of those trying to access schemes.
Many drug users across the region, where lengthy jail sentences for possession of even the tiniest amounts of drugs – for instance the residue in a used syringe handed in at a needle exchange centre – are the norm, have reported being beaten, tortured, blackmailed or even falsely imprisoned by police.
A spokesman for the International HIV/AIDS Alliance in Ukraine, where OST and needle exchange schemes ostensibly have government backing, told IPS: “Physical and other intimidation towards drug users is routine police practice.
“Drug users, sex workers, and service providers have spoken of how police have extorted money and information from drug users through severe beatings, electric shocks, partial suffocation with gas masks, and threats of rape.
“They have also reported that police planted drugs in their homes or on their persons, and used this as evidence to arrest or abuse them.”
Discrimination of drug users also extends to the provision of antiretroviral (ARV) drugs.
The International HIV/AIDS Alliance in Ukraine told IPS that denying drug users ARV drugs was a “common problem”, although there is no way of officially proving it.
The Eurasian Harm Reduction Network also told IPS similar incidents had been reported in Russia.
The WHO estimates that only 23 percent of people who are eligible for HIV drugs in the EECA actually receive them. The figure in sub-Saharan Africa is more than double that.
Local groups working to combat the disease say until Western healthcare approaches to HIV/AIDS treatment and prevention are adopted, the region is unlikely to get the epidemic under control.
Ocheret told IPS: “Countries like Poland, for instance, introduced western healthcare practices on HIV/AIDS, including OST, in the 1990s when it had a difficult problem with HIV/AIDS and by doing so managed to get the problem under control.
“In many EECA countries these programmes remain in perpetual ‘pilot’ stages and have never developed further.”